Methadone

The Social Support Networks and Need for Social Support Among Adults with Chronic Pain who are Enrolled in Methadone Treatment

Summary of the Project

The goal of this study is to conduct qualitative research over a two year period to explore and describe needs for social support among adults with chronic pain who are enrolled in a methadone treatment (MT) program. This research is unique in that the target population (i.e., people who demonstrate manifestations of addiction to opioids in the management of chronic pain) is one that has not been studied to any extent in the context of social support. It is also unique because it includes the perspectives of both the target population and their MT providers. One of the significant tasks of MT is to incorporate relationships with people who do not use drugs and support the person in his/her treatment. This constructive social support is often less available for people who are addicted to drugs than to those who are not. People who are addicted to opioids are often embedded within a network of others who are substance users; it provides support to the person but it also tends to reinforce continued use of drugs. Over the course of addiction, substance users’ pre-addiction supports may disappear or deteriorate. Consequently, people in MT often lack the resources and skills to engineer new social networks. They tend to leave MT to return to their pre-treatment relationships and therefore do not sustain treatment goals. Methadone treatment is stressful because it requires many changes in behavior and relationships. People with chronic pain, however, are often afraid that enrollment in MT will mean that their pain will be inadequately controlled, and they are often reluctant to be associated with “addicts.” Recently, researchers have determined that substance abuse is a significant issue among many people with chronic pain, although there continues to be debate about the actual extent of the problem. As well, there is recent awareness that addiction in chronic pain has unique features that make it difficult to transfer research findings from other populations. Although addiction is widely acknowledged as a significant public health problem in Canada, empirical evidence about social support in MT has been derived from cities such as Vancouver and Toronto that have issues characteristic of large urban centers, such as exceptionally high rates of drug overdose. The current trend is to develop social support interventions, based on the needs of particular populations in specific locations, in order to address the complex social phenomenon of retention in addiction treatment; however, as there is little data available in other than large metropolitan centers, this strategy has been difficult to enact in provinces that are considered rural, such as New Brunswick (NB). The need for this research study evolved as a response to the significant problem of prescription opioid use among people in NB who are managing chronic pain. The 2003 case of a 20-year-old’s death due to an overdose of prescribed opioid analgesics sparked provincial concern about this as a widespread issue. Expert witnesses in the inquest hearing stated that New Brunswick has “one of the highest per capita dispensing rates for legal narcotics in Canada.” A report of the Canadian Community Epidemiology Network on Drug Use in 2003 noted that 142 people who were addicted to prescription drugs were admitted to the Fredericton Detoxification centre in 2002-2003. A recent survey of clients receiving methadone in a community clinic in Fredericton, NB revealed that 26 of the 68 respondents had become addicted to opioids to manage their chronic pain. This is congruent with other research that has demonstrated that almost half of those with chronic pain enrolled in MT attributed their addiction to prescribed opioids.

Another impetus for the research is that the provincial government of NB has announced that it will develop a province-wide system of methadone delivery by 2008; it will be housed in Addictions Services Departments and offer MT to illicit drug users. Staff of Addictions Services in the province plan to incorporate elements of effective MT delivery, including social support, in the development of the province-wide MT plan; however, little empirical evidence that is specific to the population of NB, or to people with chronic pain, exists to guide their planning.

Members of the Team

Primary Investigator:

Barbara Paterson
Faculty of Nursing
University of New Brunswick

Co-Investigators:

Miriam Stewart
Social Support Research Program
University of Alberta

Nicole Letourneau
Faculty of Nursing
University of New Brunswick

Cheryl Gibson
Faculty of Nursing
University of New Brunswick

Judith MacIntosh
Faculty of Nursing
University of New Brinswick

Benedikt Fischer
Department of Publc Health Sciences
University of Toronto